Medscape Ethics Report 2018: Life, Death, and Pain

Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

On a daily basis, physicians confront difficult decisions regarding patient care. Most often, the hardest choices come in weighing the life and death of a patient as well as dealing with their pain. No matter the specialty, making these judgement calls can challenge any healthcare professional. Medscape surveyed more than 5200 physicians in over 29 specialties to find out how they feel about the key issues they wrestle with today.

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

According to a 2018 Gallup poll, 72% of Americans say doctors should be able to help terminally ill patients die. That number dipped to 65% when the question asked whether doctors should help patients "commit suicide."[1]

"This option seems to have been successful and appropriately used in the few states where it is legal. It is also humane." —Ob/gyn

"It depends upon the terminally ill condition. Both depression and psychosis can be considered terminally ill in some instances. I guess I just don't trust my physician colleagues to make the correct decision all of the time." —Gastroenterologist

"Too often, doctors are wrong. It is wrong to take a life. The physician's oath is to do no harm." —Pediatrician

"There is too much suffering at the end of life—not just pain, but loss of quality of life!" —Internist

Some totals in this presentation do not equal 100% due to rounding.

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"I would go one step further and state that any person with formally declared competence, regardless of terminal illness, should have the right to self-determination, to include assisted suicide." —Male critical care physician

"It is a patient right if all of the legal prerequisites are met." —Female internist

"Patients get to decide. All systems such as this currently in existence appear to have good safeguards." —Male anesthesiologist

"I have watched too many folks who have gotten their affairs in order, said their goodbyes, and then lived day to day in horrible pain waiting for their bodies to given up and die. It is terrible for the patient and their family." —Female ob/gyn

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"I'm not sure this should be left to legislators." —Internist

"There's a fine line, but a very clear line, between making a patient comfortable and killing them." —Family physician

"Too many new advances in the medical frontier to go down this path." —Allergist/immunologist

Medscape Ethics Report 2018: Life, Death, and Pain

"Most physicians already provide pro bono care in the context of their own practices. Obligatory charity is an oxymoron." —Hematologist

"I think it should be their choice. It may want to be incentivized as a charitable donation, which can be included as a legitimate tax deduction if the provider chooses." —Internist

"A good emotional buffer against burnout." —Psychiatrist

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

Although the overall average of "yes" replies was 23%, that number was higher among cardiologists (35%) and family physicians (31%).

"Once the exam room door closes, there is no room for that in the physician/patient relationship." —Emergency medicine

"[You] have to do it in a respectful and professional way. Be careful to never make the patient feel you would hold their agreement or disagreement against them." —Family physician

"In general, for a physician to casually discuss political beliefs with his patients, especially those not known to him personally in the community, is a betrayal of the patients' trust in his/her neutrality." —Psychiatrist

"If patients ask a physician a question, and the physician chooses to answer, that is between the patient and physician." —Family physician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"The information belongs to the patient. They can request you don't tell them, but you can't withhold." —Pediatrician

"They need to be able to plan appropriately for outcomes, depending on their likelihood." —Family physician

"It depends on what the patient has requested to know prior to doing the genetic testing." —Pediatrician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

There was a slight shift in physicians answering "no" (42%) from the 2016 Medscape Ethics Report. Whereas "it depends" remained the same, more physicians who answered "yes" (22%) 2 years ago now say they would not take this action.

"Only under the most unusual of circumstances…perhaps for a short period of time while an important relative traveled to say goodbye. Definitely not prolonged if truly futile." —Neurologist

"This is morally and ethically wrong." —Allergist/immunologist

"Only to buy time for family to be present." —Psychiatrist

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"I would not recommend, but if the patient and family want [the therapy, I] may have no choice." —Oncologist

"We need to be affirmative that if it is futile, it will be a burden on patient, family, and community." —Cardiologist

"In the emergency department, this is complicated, but there are so many instances where lifesaving procedures are futile and we have to do them. There should be more leeway." —Emergency medicine

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"If anything, there seems to be undue delay once clinical criteria for survival are established." —Internist

"Too often, we do too much to delay the inevitable. I think allowing a natural death is preferable to an expensive stay in an ICU that benefits very few." —Family physician

"The medical decision is done in a timely fashion, but the family delays the process until a consensus is reached." —Anesthesiologist

"I think the interest in harvesting organs may override the best interests of the family." —Ophthalmologist

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"This would depend on the real probability and the apparent motives of the family." —Internist

"In selected circumstances, I might elect for an ethics consult if I felt the patient's interests were not being prioritized." —Neurologist

"I would continue to stress the inevitability of the disease process to the family until they allow me to decide the outcome of the patient." —Family physician

"I would talk further with the family and possibly with a skilled attorney before stopping suitable treatment unless [the] patient's outlook is futile." —Emergency medicine

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"Some treatments may be futile and patients need to know that." —Family physician

"[Yes], with enough discussion of known treatment options." —Nephrologist

"Only those available experimentally, otherwise, we are giving false hope and likely causing more harm than good." —Internist

"There is nothing to lose and possibly everything to gain for themselves and others if it works." —Neurologist

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"Only if giving information would be detrimental to the patient and the family has requested they are not informed, such as [in the case of] untreatable terminal cancer." —Emergency medicine

"Sometimes, bad news has to be given in stages when appropriate and as per the patient's needs." —Family medicine

"Have been in this situation; the only possible exception would be a patient who does not have capacity to understand the situation, but even there I'd endeavor to inform appropriately." —HIV/infectious disease physician

"Although difficult, the patient needs the truth." —Internist

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

In 2016, 52% of all physician respondents said "no" to this same question.

"We have an obligation to treat and alleviate their pain." —Nephrologist

"I do it routinely." —Family physician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

Two years ago, among ob/gyn physicians, 55% said they perform an abortion if it were against their personal beliefs.

"Yes, if there was possible harm to the mother if I did not." —Emergency medicine

"My religious beliefs should not impact my patient." —Nephrologist

"If the pregnancy threatens the mother's life and an ethics committee recommends termination." —Ob/gyn

"I have never performed an abortion and never will. Period." —Ob/gyn

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"I would fully educate them on the risks they are taking, and make them sign a waiver that they are risking their children's lives with their decision, but that it is, at the present time, their legal right to do so." —Family physician

"[Yes]; however, they are the ones that should pay higher insurance rates or be noncovered for preventable diseases." —Anesthesiologist

"We have a no-acceptance policy for parents that don't give core vaccines." —Pediatrician

"Of course! And I'd keep trying new perspectives and informing them of the benefits of vaccines." —Family physician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

This year's "yes" replies are more numerous than they were in 2016 for family physicians (60%) but are less so for both internists (64%) and pediatricians (51%).

"Everyone deserves medical care. I would try to educate them and maybe slowly get them to see the benefit of vaccines. In the meantime, they may still need medical care." —Family physician

"Treatment, including vaccines, is a personal decision honoring patient autonomy. Our job is to educate to the best of our ability." —Internist

"I think major vaccinations should be given, but timing can be a bit more flexible than current recommendations that give a large number of shots at once. I also am not convinced that every one of the recent vaccinations is absolutely necessary for everyone." —Pediatrician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"It is the patient's (and their family's) decision. Not mine. I would want full information, and I treat my patients with the same respect I would expect." —Allergist/immunologist

"Patients still need to know the risks/benefits regardless." —Cardiologist

"There should always be patient choice." —Family physician

"[Yes], although needless to say, we need to make sure the patient understands all the risks of the procedure." —Pediatrics

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

With a proposal in the United Kingdom for an organ donation opt-out system slated for 2020, a new survey indicates that 1 in 10 people would take that step. The research, conducted by the University of Stirling, noted that those of the 1200 surveyed who said they would opt out reported stronger emotional barriers toward organ donation.[2]

"This has to be consented to, just like any other medical procedure." —Psychiatrist

"People may have religious objections to donating their organs. The family should not have to prove this when their loved one is dead/dying." —General surgeon

"[The] problems with this are for those with HIV, chronic hepatitis C that failed to respond to treatment, and other chronic diseases. This gets into a privacy issue." —Internist

"This would be lifesaving and has been successful in several other countries." —HIV/infectious disease physician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"We did not pay for our organs; therefore, we should not sell them." —Anesthesiologist

"The potential for criminal acts is just too high." —Cardiologist

"This is a complicated situation, but ultimately, I believe people should be able to do this." —Family physician

"Allowing this could lead to all kinds of abuse, including blackmail and other types of coercion of people to get organs." —Critical care physician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

According to the Department of Health and Human Services, as of September 28, 2018, 586 (7%) of all deceased donors in the United States were over 65 years of age.[3]

"It depends on the overall health and expected longevity of the person. Age alone should not be the sole factor." —Family physician

"Age itself should not be a determinant. Obviously, people over 70 are much more likely to have other issues that make them less desirable candidates." —Pediatrics

"If and only if there is a reasonable and independent assessment of life expectancy, and an adequate supply for others with a longer life expectancy." —Anesthesiologist

"Old age is expanding chronologically, and many nonagenarians are beneficial recipients." —Ob/gyn

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"Advising a patient what to do about an incident several years ago, where she described inappropriate touching by the radiologist who reviewed her mammogram with her in his private office." —Family physician

"A patient revealed he was blacking out but continued to drive. At that time, it was illegal to divulge that information to authorities based on state law. (Law has since been changed.)" —Dermatologist

"My biggest ethical dilemma is how to approach harassment at the workplace. Many of us face it, and somehow, if leadership isn't good, they force decisions on others rather than work in a healthy collaborative environment." —Nephrologist

"How to tell a family their infant had preleukemia and was going to die after a lab made an error that cost an early diagnosis." —Pediatrician

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Medscape Ethics Report 2018: Life, Death, and Pain

Keith L. Martin | December 12, 2018 | Contributor Information

"What to do with patients with poor compliance with treatment." —Psychiatrist

"Whether to prescribe an opiate or not." —Physician medicine

"Dealing with divorced parents who are more interested in their animosity than their children's well-being." —Pediatrician

"Attempts by mothers or husbands to get confidential information without a specific signed release from the patient. We often get threats of legal action or actual physical violence or retaliation. We get threats by the carrier of the insurance to instruct the carrier not to reimburse for our services." —Ob/gyn